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Frequently Asked Questions Insurance

Privacy of Medical Information

We suggest that you look at The Department of Health and Human Services website (specifically HHS's Office of Civil Rights), since they are tasked with writing and enforcing these regulations. Here are two links:

The Privacy Rule permits OPM to impose reasonable, cost-based fees. The fee may include only the cost of copying (including supplies and labor) and postage, if you request that the copy be mailed. We expect to charge an amount similar to that used for Freedom of Information Act (FOIA) requests.

If you believe that OPM is not complying with a requirement of the Privacy Rule you may file with either OPM or the Department of Health and Human Services (HHS) Office of Civil Rights a written complaint, either on paper or electronically. This complaint must be filed within 180 days of when the complainant knew or should have known that the act had occurred. For more information on how to file a complaint with OPM, please review our NPP. For instructions and information on how to file a complaint directly with HHS, please refer to their website www.hhs.gov/ocr/hipaa/.

When you file a disputed claim, you give OPM permission to review any information related to that claim, including medical information your FEHB plan used to make its initial determination as well as medical information you submitted to your FEHB plan or directly to us to support your claim. Information from your plan is provided to OPM so that we may make a determination on benefits.

The Health Insurance Portability and Accountability Act (HIPAA) requires that we prepare and distribute our Notice of Privacy Practices. Since all individuals enrolled in the Federal Employees Health Benefits (FEHB) Program receive a copy of their Plan brochure, we believe that this was the most cost-effective way to ensure that we complied with this requirement.

The Health Insurance Portability and Accountibiliy Act of 1996 (HIPAA) is a Federal law that provides far-reaching health insurance reforms and medical privacy protections for all Americans. Title 1 of HIPAA offers important, though limited, Federal protections that improve the availability and continuity of health coverage for workers and their families. Under certain conditions, this law guaranteees the availability of new health coverage with no exclusions for pre-existing conditions for individuals who lose employment-based health coveragedue to changes in employment or family status. The department of the Treasury, Labor, and Health and Human Services are jointly responsible for Federal rules conserning health enforcment authority to the individual sstates and allows states to impose more generous protections that those under HIPAA, a key source of information for individuals is your State Insurance Commissioner.

Generally, no. OPM does not process claims, and does not have access to your personal medical information. The exception is if you have filed a disputed health benefits claim with us. If you have not filed a disputed claim we do not have any of your personal health information.

The Notice of the Office of Personnel Management's Privacy Practices (NPP) is a document that describes how OPM may use and give out-- "disclose"--individually identifiable health information -your personal health information.

The Notice of Privacy Practices provides details on how to get this information. You have a right to file a complaint directly with us, or request information we may have about you. We will respond to all written inquiries requesting a copy of your medical information held by OPM.

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